DBT EXAM 1 QUESTIONS & ANSWERS
What is an environmental intervention? What are the three reasons to justify it? -
Answer --
1. The outcome is essential
2. The pt clearly does not have the power or the capability to produce the outcome
3. The environment has high power relative to the pt, and the therapist needs to step in
and equalize the power distribution
What are the three types of biological vulnerability to emotions? - Answer -· High
sensitivity to emotional stimuli
· High extremity of emotional responding
· Slow return to baseline
What are the three main characteristics of an invalidation environment? - Answer -·
Indiscriminate rejection of expression of a person's internal experiences
· Intermittent reinforcement of escalation of emotional responses
Oversimplification of problem solving
1. What is the primary hierarchy of targets in Stage 1?
2. For the top two targets, what are the three sub-targets? - Answer -1.
2. (i)
(ii)
(iii)
What is the primary question to ask in doing a dialectical assessment? - Answer -What
is being left out?
What are DEAR MAN skills used for? - Answer -they are within interpersonal
effectiveness skills and they are objectives effectiveness skills which help us to be as
effective as possible in achieving our objectives or goals
What does DEAR MAN stand for? - Answer -Describe the situation
Express clearly
Assert wishes
Reinforce
(stay) Mindful
Appear confident
Negotiate
What are the three pairs of the six secondary targets? - Answer -1. Emotional
Vulnerability and Self-Invalidation
2. Unrelenting Crises and Inhibited Grieving (Trauma & Experiential Avoidance)
3. Apparent Competence and Active Passivity (Help Seeking - Communication)
, What are the Stages of Disorder (I to IV) in DBT in terms of the problem and goal for
each? - Answer -Stage I. Severe Behavioral Dyscontrol with GOAL Stability and
behavioral control
Stage II. Quiet desperation with GOAL non-anguished emotional experiencing
Stage III. Problems in living/less severe disorders with GOAL ordinary
happiness/unhappiness
Stage IV. Incompleteness with GOAL freedom and capacity for joy
Give an example of a clinical situation in which your client (family) is having problems
with other professionals and an example of strategies you could do, which are:
(a) pure consultation to patient
(b) pure environmental intervention
(c) one strategy in between - Answer -(a)
(b)
(c)
What are the four primary change procedures in DBT? - Answer -1. skills training
2. contingency management (i.e., reinforcers, punishment)
3. cognitive modification
4. exposure-based strategies
What are Level 4 and Level 5 validation? What makes them different and why is 5 better
than 4? - Answer -Level 4. Understanding
a. In particular this level of understanding is often down in terms of the past, so person's
learning experiences, and/or biology
i. EX: his client with the stomach virus - this is impacting her emotional and behavioral
b. NEVER VALIDATE IN TERMS OF BIOLOGY AND PAST EXPERIENCES WHEN IT
IS APPROPRIATE TO VALIDATE IN THE PRESENT CONTEXT (AKA don't do IV if V
is appropriate)
i. EX: wife and dishes - this just reminds you of your parents arguing
Level 5. Acknowledge the valid particularly in terms of the present context
a. EX: spoke with client earlier today who has gone through long custody and divorced
battle and suspected that lawyer has not been diligent with his job and her ex-husband's
legal team has tried to actively delay things - date "wrong" for mediation - occasionally
people say, that is just me having my crazy BPD reactions - but if you plug anyone into
her shoes, they are going to be dysregulated and anxious, and frustrated and
depressed - validate this experience and don't do anything to make things worse
b. FUNCTIONAL VALIDATION
EX: of course, you are upset, I told you I would do the dishes for 3 days and I am really
sorry is there anything else I can do to make it up
What are 5 of the types of links to look for when doing a chain analysis? - Answer -1.
Thoughts
2. Emotions
3. Actions
4. Sensations
What is an environmental intervention? What are the three reasons to justify it? -
Answer --
1. The outcome is essential
2. The pt clearly does not have the power or the capability to produce the outcome
3. The environment has high power relative to the pt, and the therapist needs to step in
and equalize the power distribution
What are the three types of biological vulnerability to emotions? - Answer -· High
sensitivity to emotional stimuli
· High extremity of emotional responding
· Slow return to baseline
What are the three main characteristics of an invalidation environment? - Answer -·
Indiscriminate rejection of expression of a person's internal experiences
· Intermittent reinforcement of escalation of emotional responses
Oversimplification of problem solving
1. What is the primary hierarchy of targets in Stage 1?
2. For the top two targets, what are the three sub-targets? - Answer -1.
2. (i)
(ii)
(iii)
What is the primary question to ask in doing a dialectical assessment? - Answer -What
is being left out?
What are DEAR MAN skills used for? - Answer -they are within interpersonal
effectiveness skills and they are objectives effectiveness skills which help us to be as
effective as possible in achieving our objectives or goals
What does DEAR MAN stand for? - Answer -Describe the situation
Express clearly
Assert wishes
Reinforce
(stay) Mindful
Appear confident
Negotiate
What are the three pairs of the six secondary targets? - Answer -1. Emotional
Vulnerability and Self-Invalidation
2. Unrelenting Crises and Inhibited Grieving (Trauma & Experiential Avoidance)
3. Apparent Competence and Active Passivity (Help Seeking - Communication)
, What are the Stages of Disorder (I to IV) in DBT in terms of the problem and goal for
each? - Answer -Stage I. Severe Behavioral Dyscontrol with GOAL Stability and
behavioral control
Stage II. Quiet desperation with GOAL non-anguished emotional experiencing
Stage III. Problems in living/less severe disorders with GOAL ordinary
happiness/unhappiness
Stage IV. Incompleteness with GOAL freedom and capacity for joy
Give an example of a clinical situation in which your client (family) is having problems
with other professionals and an example of strategies you could do, which are:
(a) pure consultation to patient
(b) pure environmental intervention
(c) one strategy in between - Answer -(a)
(b)
(c)
What are the four primary change procedures in DBT? - Answer -1. skills training
2. contingency management (i.e., reinforcers, punishment)
3. cognitive modification
4. exposure-based strategies
What are Level 4 and Level 5 validation? What makes them different and why is 5 better
than 4? - Answer -Level 4. Understanding
a. In particular this level of understanding is often down in terms of the past, so person's
learning experiences, and/or biology
i. EX: his client with the stomach virus - this is impacting her emotional and behavioral
b. NEVER VALIDATE IN TERMS OF BIOLOGY AND PAST EXPERIENCES WHEN IT
IS APPROPRIATE TO VALIDATE IN THE PRESENT CONTEXT (AKA don't do IV if V
is appropriate)
i. EX: wife and dishes - this just reminds you of your parents arguing
Level 5. Acknowledge the valid particularly in terms of the present context
a. EX: spoke with client earlier today who has gone through long custody and divorced
battle and suspected that lawyer has not been diligent with his job and her ex-husband's
legal team has tried to actively delay things - date "wrong" for mediation - occasionally
people say, that is just me having my crazy BPD reactions - but if you plug anyone into
her shoes, they are going to be dysregulated and anxious, and frustrated and
depressed - validate this experience and don't do anything to make things worse
b. FUNCTIONAL VALIDATION
EX: of course, you are upset, I told you I would do the dishes for 3 days and I am really
sorry is there anything else I can do to make it up
What are 5 of the types of links to look for when doing a chain analysis? - Answer -1.
Thoughts
2. Emotions
3. Actions
4. Sensations
